Obama vs. McCain

This article is based on stated positions, conversations with health policy advisors and the Senate records of Sens. John McCain and Barack Obama. Much of it speaks in general terms with details not yet spelled out — and unlikely to be — until the new president's first budget is submitted in February 2009.

While recent presidential budgets have been declared dead on arrival, the next president's proposed federal budget will be submitted during what is likely to be a brief honeymoon period and, as a result, will be important in establishing the new administration's priorities.

Sen. Obama has already stated publicly that, if elected, he plans to address health care reform within the first hundred days of his administration; Sen. McCain has not yet announced a timetable for health reform.

The makeup of the Congress and in particular the Senate will determine how much of any proposed new programs can be enacted. A filibuster-proof Senate would greatly increase the odds of broad action, yet Republicans are expected to stay within the narrow minority margin in the upcoming November election.

With a Democratic-controlled Congress, some say revamping federal health policy might be marginally easier during an Obama presidency because of the so-called “cooperation factor” between the congressional majority and the new administration.

Neither Obama nor McCain, however, has articulated any specific or formal position regarding the immediate issues most critical to our industry, such as the competitive bidding program. These issues are far more detailed than campaigns usually address. Following are the larger health policy issues that have been communicated by the two presidential candidates.

Key Advisors

Presidential advisors, especially the chief of staff, domestic policy advisor and director of the Office of Management and Budget, will be critical. Key players are categorized here as either “high-level health advisors” (big picture surrogates and potential HHS appointees) or “details” advisors (staff who are well-versed in policy minutiae, including current Senate health staff).

• Health Reform

  Obama high-level health advisors: Former Sen. Tom Daschle; David Cutler (Harvard Kennedy School economics professor, member of Council of Economic Advisors under President Clinton); David Blumenthal, MD (ex-advisor to Sen. Ted Kennedy, Director of the Institute of Health Policy at Mass General Hospital); and Stu Altman (Dean of the Brandeis University School for Social Policy & Management).